Primary Care Quality Report Finds Weak Spots

OHSU and Eastern Oregon physicians draw “below average” scores in a survey conducted by the Oregon Health Care Quality Corporation.
March 4, 2010 -- A review of major medical groups and more than 300 physician offices around the state has incited serious conversations about measuring the quality of care in Oregon.
By grading providers “better,” “average” or “below average” using billing records, an advocacy organization has focused attention on the weakest areas of the state’s healthcare system.
Through the “Partner for Quality Care: Information for a Healthy Oregon” initiative, which went public on Feb. 25, consumers can now learn how their physicians rank based on their quality of care.
Last year, the group put out a similar quality report on hospitals.
“We have plenty of room to improve,” said Nancy Clarke, executive director of the Oregon Health Care Quality Corporation, which led the initiative. “The first step in quality improvement is to get rid of the variation. Then we can move the whole system’s quality up.”
The survey measured four highly watched areas—asthma medication, women’s health, diabetes and heart disease. The results were calculated based on the percentage of patients who received a recommended healthcare service. Physicians who had statistically significant higher percentages were reported as “better.”
Results came from claims data submitted between 2006 and 2009 by Oregon’s largest health plans—CareOregon, HealthNet, Kaiser, Lifewise, ODS, PacificSource, Providence and Regence BlueCross BlueShield.
In the Portland metro area west of the Willamette River, Oregon Health & Science University was the only medical group to score “below average” in all categories besides women’s preventive health, where OHSU scored “better” in testing for chlamydia, and “average” for breast and cervical cancer testing.
The low scores could be the result of the number of at-risk patients seen by OHSU, which wasn’t considered by the survey, Clarke admitted. “Some of those OHSU clinics are working with challenging populations, with high proportions being low-income or minority,” she said.
Ken Olsen, public relations spokesman at OHSU, acknowledged that difficulty. “We get the most complicated cases, so our population would have been much higher risk than others in the survey,” he said.
It was also difficult to analyze the data from OHSU because its clinics use residents and rotating faculty members, Clarke said.
Looking at diabetes care, physicians in eastern Oregon scored “below average” at a much higher rate than elsewhere.
A majority of those physicians also had lower scores when doing eye exams, and when conducting tests for blood sugar, cholesterol or kidney disease. In all categories of care, about 66 percent of physicians in Oregon had “average” scores.
Clarke qualified the significance of these rural disparities. “They definitely have significant challenges in rural areas, but there are a lot of clinics doing good work. They also don’t have as much data in central and eastern Oregon so the margin of error would be higher there.”
Mike Leahy cautioned against using these survey results to discriminate against physicians, particularly those in rural communities. “Basic primary care information is important for us to have, but the important thing is not to pick apart the baseline to say that you’re a winner and you’re a loser,” said Leahy, a visiting health sciences professor at Linfield College and a clinical family medicine instructor at OHSU. “Higher proportions of the population in eastern Oregon are poor and unemployed.”
Using the effects on schools of the 2001 No Child Left Behind Act as an example, Leahy warned that punitive use of this data could detrimental for public health policy. The federal initiative to close underperforming schools hasn’t improved the public school system, said Leahy, the founder and CEO of the Oregon Community Health Information Network.
Although the survey relied on claims data, Leahy firmly believes electronic health records have an important role to play because services such as telephone conversations between physicians and their patients can be included. Electronic data also shows how often physicians track recommended services.
Electronic data will be part of future surveys, said Clarke, who wants to focus on helping physicians improve their quality rather than punish those with lower scores. “A significant cultural shift is needed to go from ‘I’m responsible for that patient who comes in’ to ‘I’m responsible for every patient’s total health,” she said. “We do not have a payment system in Oregon that reinforces quality.”

Learn More

For an explanation of the data measurements click here.
Also take a look at The Lund Report’s series on the shortage of primary care physicians in Oregon Part 1, Part 2, Part 3, and Part 4.


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So is Dr. Leahy saying that measurement of performance or quality should not be done in education or health care? Should we not have measures of performance or accountability for teachers, doctors, patients, children? Don't know about you, but where I work, performance and quality measurement is a routine. It helps us know where to prioritize efforts, and it helps us to know how we're doing. Should health care and education get a "bye"? It's not as though these areas are performing well.